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Medical necessity appeals definition:
Appeals related to a medical necessary denial are processed by Humana Military.
For additional detail and timeliness instructions:
Learn how to file an appeal with Humana Military
The appeal process is only applicable to charges denied as not covered or not medically necessary and are only accepted from appropriate appealing parties. A proper appealing party is:
Note: A completed Appointment of Appeal Representative (AOR) form must be submitted with the appeal request. Appointed representatives MAY include:
Who cannot appeal:
Appointment of representative:
Appointment of representative and authorization to disclose information
Appeals submission:
HMHSRECON@humana.com (Preferred method)
Humana Military Appeals
PO Box 740044
Louisville, KY 40201-7444
Allowable charge appeal definition:
If a provider or a beneficiary has concerns about how a claim processed, an administrative review, also known as an allowable charge review, can be requested. It’s important to differentiate allowable charge reviews from medical necessity denial appeal requests.
Providers can submit a request for an administrative review when there are concerns about how a claim processed. The following are common reasons a provider may submit a request for administrative review: a request for administrative review, including:
Allowable charge appeals are processed by WPS.
Allow charge submission:
Customer Service
TRICARE East Region
PO Box 8923
Madison, WI 53708-8923
Hours of operation:
8AM to 7PM ET
Phone: (800) 444-5445
Fax: (608) 221-7536
Claims reconsideration definition:
Participating providers may have claims reconsidered through medical review for issues including:
NEW! Reconsideration FAQs
Claims reconsideration submission:
Customer Service
TRICARE East Region
PO Box 8923
Madison, WI 53708-8923
Hours of operation:
8AM to 7PM ET
Phone: (800) 444-5445
Fax: (608) 221-7536